RN Case Manager, Telehealth

Navitus; Raleigh (NC); A distancia; USD 80.000 - 110.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Health insurance

Dental insurance

Vision insurance

PTO 20 days

Parental leave 4 weeks

Holidays 9

401K match 5%

Adoption assistance

FSA

Education assistance

Membership assistance

Referral bonus $750

Descripción de la vacante

Navitus Health Solutions seeks a Telehealth RN Case Manager to deliver MTM services for commercial and Medicare members. The role focuses on expanding MTM programs, improving care coordination, and supporting STAR ratings outreach through clinical engagement.

The position requires an unrestricted RN license, 2 years of clinical experience, and ability to work in a multidisciplinary team. Telehealth and remote collaboration are key aspects of the role.

Formación

• Unrestricted RN licensure is required.
• 2 years of clinical experience preferred.
• Experience on multi-disciplinary teams beneficial.
• PBM industry experience preferred.
• Knowledge of HIPAA and healthcare privacy practices.
• Understanding of healthcare industry practices.

Responsabilidades

• Conduct MTM and CMS-aligned clinical programs.
• Develop MTM algorithms, pathways, and call scripts for MTM delivery.
• Review and update all algorithms and call scripts yearly.
• Develop documentation standards for clinical outreaches.
• Assist leadership to develop programs supporting STAR ratings outreach.
• Facilitate communication with clients, providers, and internal staff about MTM programs and outcomes.
• Provide Medicare Part D clinical and educational support and stay updated on regulations.
• Stay current with guidelines and medications to keep MTM programs up to date.
• Other duties as assigned.

Conocimientos

RN licensure

Clinical experience

Team collaboration

HIPAA knowledge

PBM experience (preferred)

Compliance awareness

Communication skills

Educación

Nursing license

Descripción del empleo

Overview

The expected start timeframe for this position is January 2027 or later.

Our team is growing! We’re excited to be expanding our team with a new Telehealth RN Case Manager position. If you’re ready for a new challenge and an opportunity to use your nursing skills in a different way, check out the openings and take your next step with us!

The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member’s health and wellness via tele-pharmacy and wellness coaching. This Telehealth RN is responsible for the delivery of the Medication Therapy Management (MTM) services for commercial and Medicare members. In addition, the Telehealth RN will assist in the development and execution of additional clinical outreach programs to exceed client expectations.

Is this you? Find out more below!

Responsibilities

How do I make an impact on my team?

• Conduct medication therapy management (MTM) and expanded clinical programs in accordance with the Centers for Medicare & Medicaid Services (CMS)
• Develop appropriate clinical algorithms, pathways, and call scripts to support pharmacy staff in delivering MTM services
• Review and update all algorithms and call scripts at least yearly and with updated clinical guidelines
• Develop documentation standards for all clinical outreaches
• Assist CEC leadership to develop program to support STAR ratings outreach
• Facilitate communication and education to clients, providers, and internal staff regarding MTM programs and program outcomes
• Provide clinical outreach to members, prescribers, and pharmacy providers to enhance care coordination
• Provide Medicare Part D clinical, operational, and educational support by maintaining knowledge of all existing updates and regulations regarding the MTM program and Medicare Part C and D performance measures (STAR ratings)
• Stay current with new guidelines, literature, recommendations, and medications, and integrate that information into the MTM and STARs programs, such that our clinical outreaches remain up to date
• Other duties as assigned

Qualifications

What our team expects from you?

• Registered Nurse with unrestricted licensure
• Two years clinical experience including direct consultation experience preferred
• Experience as a member of a multi-disciplinary team is preferred
• Professional PBM industry work experience is preferred
• Knowledge of applicable data privacy practices and laws is preferred
• Knowledge of healthcare industry practices and HIPAA regulations
• Participate in, adhere to, and support compliance program objectives
• The ability to consistently interact cooperatively and respectfully with other employees

What can you expect from Navitus?

• Top of the industry benefits for Health, Dental, and Vision insurance
• 20 days paid time off
• 4 weeks paid parental leave
• 9 paid holidays
• 401K company match of up to 5% - No vesting requirement
• Adoption Assistance Program
• Flexible Spending Account
• Educational Assistance Plan and Professional Membership assistance
• Referral Bonus Program – up to $750!

#LI-Remote

Navitus Health Solutions is an Equal Opportunity Employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin, age, disability, genetic information, veteran status, or any other characteristic protected by law.

Equal employment opportunity, including veterans and individuals with disabilities.

PI288004420